title: Fluid supplementation in hyperbilirubinemia.
abstract: OBJECTIVE
  To analyze the factors responsible for failure of fluid supplementation in full-term neonates with severe non-hemolytic hyperbilirubinemia.
  
  
  METHODS
  The data from two previous randomized controlled trials was used in this study. Full-term (≥37 wks) neonates with severe hyperbilirubinemia (serum total bilirubin 18-25 mg/dL), who received intravenous fluid supplementation in addition to phototherapy were included. Intravenous fluid supplementation was given for 8 h. Those neonates, whose serum bilirubin levels increased by 2 mg/dL or crossed 22 mg/dL, underwent exchange transfusion. The authors compared baseline serum bilirubin, sodium, and osmolality and their changes during study period in neonates who required exchange transfusion (Non-responders) with those who didn't (Responders).
  
  
  RESULTS
  The data of 121 neonates was analyzed (non-responders = 17, responders = 104). Both the groups had similar weight loss since birth, baseline serum sodium and osmolality. Mean baseline serum bilirubin [22.5 (1.7) vs 21.6 (1.6) mg/dL, p = 0.04] and cesarean/ instrumental delivery (27.6% vs 20.2%, p = 0.02) were significantly higher in non-responders. With fluid supplementation, serum sodium and osmolality changed similarly in both the groups over 8 h. On multiple regression analysis, only cesarean/instrumental delivery [OR 3.9 (95% CI-1.2, 13.4)] retained independent significance.
  
  
  CONCLUSIONS
  Fluid supplementation for severe non-hemolytic hyperbilirubinemia is less likely to be successful in neonates born by cesarean/instrumental delivery as compared to normal vaginal delivery.
authors.affiliation: Newborn Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: Shiv Sajan
authors.initials: SS
authors.lastname: Saini
authors.forename: Praveen
authors.initials: P
authors.lastname: Kumar
authors.forename: Karthik
authors.initials: K
authors.lastname: Balasubramanium
authors.forename: Shailender
authors.initials: S
authors.lastname: Mehta
mesh_terms: D005078:Exchange Transfusion, Whole Blood; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006932:Hyperbilirubinemia / Q000628:therapy*; D007231:Infant, Newborn; D008297:Male; D012720:Severity of Illness Index; D017211:Treatment Failure